Whole-heart approach

Hospitalized after a heart attack, Denise Isbell and her doctor agreed: She shouldn't be there.

By Sarah Lemon

Hospitalized after a heart attack, Denise Isbell and her doctor agreed: She shouldn't be there.

Isbell is only 37 years old, yet Dr. Christopher Cannon was telling her that a nearly complete arterial blockage, before stenting at Providence Medford Medical Center, should have killed her.

"Never did I ever think I was having a heart attack," says Isbell.

A smoker for 15 years and self-admittedly about 100 pounds overweight, the Medford resident was trying to turn her lifestyle around. Her primary-care physician, Pedro Bujosa, had prescribed three months of dietary changes to bring down Isbell's blood pressure and stave off diabetes before he intervened with pharmaceuticals.

Less than three weeks later, Isbell experienced a burning sensation in her chest after swallowing some ibuprofen. Even after she vomited, the pain persisted.

The next day — Memorial Day — the fiery feeling returned while Isbell smoked an after-dinner cigarette with family. As Isbell announced she felt "really weird," her loved ones insisted she seek medical attention.

"I affiliate the heart attack with the smoking now," she says.

Isbell's sister told staff at Providence's emergency department that Isbell was having chest pains. She was hooked up for an electrocardiogram and, minutes later, whisked into the hospital's cardiac catheterization lab.

"There was like a million doctors waiting for me," recalls Isbell. "I still wasn't putting two and two together.

"They were working so frantically ... and my sister was crying in the corner."

Isbell remembers hurting "so bad" when injected with dye to pinpoint her heart's blockage and then, once miniscule metal coils were inserted to repair damaged tissue, feeling "like a million dollars." She assumed she was headed home instead of to the hospital's intensive-care unit.

"Completely impressed" by the hospital's technology and her care, Isbell says she was just as pleased that Cannon's follow-up included prescriptions for nutrition counseling and Providence's new cardiac rehabilitation program. Her insurance pays for 36 visits, which Isbell says will keep her accountable and motivated to change.

"Why would you go there and leave and then go to McDonald's?" she asks. "I enjoy (healthful) foods that I never ate before."

Isbell is one of 18 patients referred to cardiac rehab since its doors opened this month. Although the concept of helping heart patients eat better and get fit isn't new, the program's inception at Providence is part of more comprehensive cardiac services, says James Cook, cardiologist and medical director for heart and vascular programs.

"We've always felt there was a need for cardiac rehab," says Cook. "We're hoping that everyone will get referred."

Anyone who's suffered a heart attack, coronary bypass surgery, angioplasty, valve surgery, stable angina, heart transplant or heart-lung transplant is eligible for rehab. The program will cost Providence about $300,000 annually but is a relatively small investment for potentially big savings by preventing future heart episodes, say hospital officials. The Affordable Care Act, which will enroll participants nationwide later this year, is cited as just one incentive.

"We're going to be penalized as physicians and hospitals ... for patients who come back within a short period of time," says Cook.

"We have patients who have had three heart surgeries, and they're still smoking," says Cook. "We have to change their risk trajectory."

Patients who attend all 36 sessions of cardiac rehab — reimbursable by Medicare — instead of just a few sessions reduce their death risk by as much as 58 percent, according to Providence. Because the program boosts physical strength and endurance by 20 to 50 percent, patients are much more equipped to resume physically active lives.

And rehab patients' risk while participating is very low: one cardiac arrest for every 120,000 hours of exercise and one death in every 750,000 hours of exercise, according to Providence. Outfitting patients with heart monitors during prescribed exercises helps to allay fears, say rehab staff.

"They don't feel left on their own," says Olsen. "We need to get them to start slowly."

Similar to a physical-therapy program, cardiac rehab involves supervised exercise and lifestyle counseling. Providence's sessions run from 8 a.m. to 4 p.m. Monday, Wednesday and Friday and can accommodate 24 patients per day, says Jennifer Scott, the program's exercise physiologist. The goal is to help patients reach an appropriate level of endurance "so they can do the things they love," she adds.

"Everybody's at a different stage when the come here," says Scott, explaining that patients' physical abilities could run the gamut from competitive athlete to older adult with chronic health conditions.

Initially concerned that rehab would be harder than she could handle, Isbell concedes it isn't the military-style boot-camp regimen she envisioned. She even used the program as a springboard to join the Rogue Valley Family YMCA in Medford and attend aqua aerobics classes. Nearly a month after her heart attack, Isbell has lost weight and she says she hasn't touched a single cigarette.